Health Insurance Portability

What is Health Insurance Portability?

Portability in health insurance refers to the process of switching the existing health insurance policy to a new policy from another health insurance company without losing the accrued benefits like the No Claim Bonus (NCB), waiting period credit, free medical check-ups, etc. It provides customers with the freedom to switch to a better health insurance provider in case they are unhappy with their existing insurance company. Every policyholder can opt for the portability facility provided the previous health insurance policy was renewed without any breaks.

How to Apply for Health Insurance Portability?

The process to apply for health insurance portability is given below:

Step 1: Send a portability request to the insurance company you want to switch to at least 45 days before your existing policy is due for renewal

Step 2: On receiving the portability request, the new insurer will provide proposal & portability forms and give details of the various health insurance plans available

Step 3: Select the health plan you wish to port to and submit the duly filled proposal & portability forms to the new insurer

Step 4: After receiving all the forms, the new insurer will approach your previous insurer to get details like your claim history, medical records, etc. The new insurer can also access these details from the IRDAI’s website.

Step 5: The existing insurer will provide all requested details through the IRDAI’s common data-sharing portal within 7 working days. In case there is any delay in sharing this information, the new insurer can hold the decision of accepting your porting request.

Step 6: After receiving all the information, the new insurer will decide on accepting or rejecting your portability request within 15 days. If the decision is made within this period, they will have to accept your portability application.

List of Documents Required for Porting a Health Insurance Policy

Given below is the list of documents required for health insurance portability:

• Identity proof
• Address proof

From the Previous Insurer:

• Previous years’ policy certificates
• Latest renewal notice with a clear mention of continuity in coverage
• Self-declaration by the policyholder in case of no claim
• Documents like discharge summary, investigation report, etc. if any claims have been filed

From the New Insurer:

• Proposal form
• Portability form

What is the Benefit of Porting a Health Insurance Policy?

Here are some of the most common health insurance portability benefits:

1. Protection of No Claim Bonus

   The policyholder does not lose the accumulated no claim bonus (NCB) on porting the existing health insurance policy to another insurance company.

   For instance, if the policyholder has accumulated an NCB of 30% under the existing policy, the same will be transferred to the new policy after portability.

2. Carry Forward of Waiting Period Credit

   The waiting period served under the existing health policy will be carried forward to the new policy after portability.

   For example, if the first policy has a waiting period of 2 years for joint replacement surgery and the new policy covers it after 3 years, then the policyholder will have to serve only 1 year of additional waiting period if he/she ports the policy after 2 years.

3. Lower Premiums

   Health insurance portability helps policyholders to switch to a health plan that offers coverage similar to the existing plan but for a lower premium. This is especially helpful for people whose premiums increase after they raise a claim under their existing policy.

4. Better Services

   Health insurance portability also allows policyholders to port their existing policy to another health insurance company if the services offered by the existing insurer are unsatisfactory.

   For example, if the existing insurance company has a complicated claim process or offers poor customer service, then the policyholder can port the policy to another insurer with a simpler claim process and a better customer care team.

Health Insurance Portability Rules

The IRDAI has laid down a few rules for health insurance portability that needs to be followed by both policyholders and insurance companies. Take a look at the various health insurance portability rules in India:

As per the IRDAI’s guidelines, health insurance companies must accept portability requests at policy renewal or the end of the specified exit age by offering suitable credits for all previous policy years, provided the policy has been renewed without any breaks.

Disadvantages of Health Insurance Portability

Take a look at the disadvantages of porting a health insurance policy:

1. Possible Only at Renewal

   Portability can be done only when the existing health insurance policy is due for renewal and not throughout the policy year.

2. Applicable to Similar Plans

   Policyholders can only port to similar kinds of health policies and not all types of plans. For example, a top up plan cannot be ported to a critical illness insurance plan.

3. Higher Premiums

   Sometimes, policyholders may have to pay a higher premium to avail additional coverage and benefits under the new health policy after porting.

4. Loss of Benefits

   Policyholders who decide to port from group insurance policies to individual policies may lose some of the benefits included in the previous policy.

Rejection of Health Insurance Portability Requests

While the IRDAI has empowered all policyholders with the right of portability, it has also given health insurance companies the right to reject any portability requests. As a result, all requests for portability are treated as new and are subject to scrutiny by the underwriter.

When a health insurance company receives a portability request, the underwriter assesses the risk exposure to determine the premium that needs to be charged. The insurer can reject the proposal if it is deemed unfavourable. In that case, the policyholder will have no other option but to continue with the existing insurance provider.

Top Reasons for Rejection of Health Insurance Portability Requests

Some of the most common reasons for the rejection of health insurance portability requests are:

• Inadequate information
• Delay in document submission
• Poor claim history (i.e. if multiple health claims have been made recently)
• Major differences between inclusions, exclusions and other features of the current policy and new policy
• Non-availability of previous policy documents
• Break-in policy renewal
• Higher age (especially in the case of senior citizens)
• Poor medical history
• Porting from a floater policy to an individual cover

Common Reasons to Opt for Health Insurance Portability

Take a look at some of the common reasons to opt for health insurance portability:

• Poor service quality
• Inadequate cover for specific health issues
• Slow and cumbersome claim settlement process
• Late reimbursements
• Hiked premium after a claim is made
• Hidden clauses and conditions leading to a lack of transparency
• Unacceptable co-payment clauses
• Room rent limits
• Better deals from another health insurance provider
• Lack of personalized services from a general health insurance company

Things to Consider Before Porting a Health Insurance Policy

Here are some things to consider before applying for health insurance portability:

• Analyze the coverage & benefits of the new health insurance plan and compare features like waiting periods, exclusions, co-payments etc. with the existing plan before porting.
• Make sure to check the Incurred Claims Ratio (ICR) and the Claims Settlement Ratio (CSR) of the preferred health insurance provider before porting.
• Remember to cross-check the terms and conditions of the new policy for any imposed waiting period or permanent exclusion beforehand so that there are no surprises at the time of claim.
• Start looking for new health plans for porting at least 3 months before the due date of the existing policy so that the policyholder has enough time to find the right plan.
• If the existing health policy is ridiculously overpriced or the insurer has a poor claim settlement ratio or has imposed a wide range of inhibitory clauses, then porting the policy is better than holding on to the accumulated no claim bonus.
• The underwriting norms, terms and conditions and the reasons for portability rejection may vary from one insurance company to another.

Porting from Group Health Insurance to an Individual Health Cover

People covered under group health insurance policies can port to an individual health cover. However, to switch to another insurer, they first need to switch to an individual health plan offered by their current insurer. Switching to a new insurer of the policyholder’s choice is permitted only after one year.

Health Insurance Portability FAQs